两种心肌保护液对未成熟心肌保护效果比较的荟萃分析

Two types of cardioplegia solution for immature heart protection: a meta-analysis

目的 因含血或晶体液在婴幼儿心脏手术中的心肌保护效果的优劣尚存争议,本文对使用这两种心肌保护液的前瞻性随机对照研究进行荟萃分析.方法 检索PUBMED,EMBASE及Cochrane图书馆数据库,检索策略为carioplegi和（pediatric或neonat或children或infant）.入选在婴幼儿心脏手术中比较含血或晶体心肌保护液的前瞻性随机对照试验,以血肌钙蛋白Ⅰ （cTnⅠ）水平、复跳后乳酸水平、拔气管导管时间及重症监护室（ICU）停留时间作为结局指标.采用均数差（或标准均数差）和95％置信区间（95％ CI）作为心肌保护效果差异有无统计学意义的指标.应用RevMan 5.0软件进行统计分析.结果 有5项研究符合本文纳入标准,共323例患者,分析结果显示含血停搏液可降低心脏复跳后乳酸水平（标准均数差1.1195％CI [0.14,2.08],P=0.03）;cTnI在术后4～6h（P=0.09）,12 h（P=0.53）,24h （P=0.12）两组间均无统计学差异;气管导管拔除时间（P=0.42）,ICU停留时间（P=0.25）两组停搏液组间未见统计学差异.结论 含血停搏液可在一定程度上改善心肌代谢,但尚无足够证据证明可以减少心肌损伤或改善临床指标.

Objective The advantage of blood cardioplegia and crystalloid cardioplegia in pediatric cardiac surgery is still un- der debate. We make this meta analysis to compare the efficacy of this two cardioplegia solution in the randomized controlled clinical tri- al. Methods PUBMED, EMBASE, Cochrane library were searched for clinical studies that reported postoperative lactate, cTnI, me- chanical ventilation time, and length of ICU stay after blood or crystalloid cardioplegia administration in pediatric cardiac surgery. We summarized the combined results of the data as mean difference （MD） or standard mean difference （SMD） with 95% confidence inter- vals. Results Five studies that match our eligibility criteria were identified and included a total of 323 patients. Lactate level after car- diopulmonary bypassCPB was significantly lower in blood cardioplegia group compared with crystalloid cardioplegia group （SMD 1.11, 95%CI [0.14, 2.08], P =0.03） ; cTnI release postoperative at 4-6 h （ P =0.09）, 12 h （ P =0.53）, 24 h （ P =0.12） were not significantly different between groups ; ventilation duration （ P = 0.42）, length of ICU stay （ P = 0.25） were not significantly different between groups. Conclusion Compared with crystalloid cardioplegia, blood cardioplegia can improve myocardial metabolism. But there was no evidence of improvement in myocardial damage, or clinical outcome of any cardioplegia solution.